Prognosis and clinical relevance of anisocoria-craniotomy latency for epidural hematoma in comatose patients.

Abstract

OBJECTIVE:

To determine whether the time between onset of anisocoria and surgery for hematoma evacuation in the head-injured patient is a useful prognostic variable for outcome in the comatose patient with an acute epidural hematoma.

DESIGN:

Prospective.

MATERIALS AND METHODS:

Twenty-one patients with an acute traumatic epidural hematoma and an admission Glasgow Coma Scale score of less than 8 were analyzed.

RESULTS:

Anisocoria was present in 14 (67%) patients. Mortality rate was three times higher in this group than in the patients without anisocoria; however, this difference was not statistically significant (p = 0.21, Fisher's exact test). None of the patients with an anisocoria-craniotomy latency of 70 minutes or less died and all of these patients had a good or reasonable outcome. Analysis of the anisocoria-craniotomy latency in ten patients revealed that a lapse of more than 90 minutes was associated with a greater mortality compared with patients with a latency of less than 90 minutes (p = 0.0238, Fisher's exact test).

CONCLUSIONS:

In patients with an acute epidural hematoma, reducing the anisocoria-surgery interval below 90 minutes is significantly associated with a better outcome (p = 0.0238, Fisher's exact test).

• Authors: J E Cohen, A Montero, Z H Israel
• Journal: The Journal of trauma (J Trauma) Vol. 41 Issue 1 Pg. 120-2 (Jul 1996) ISSN: 0022-5282 [Print] United States
• PMID: 8676403 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Aged
• Anisocoria (etiology)
• Craniocerebral Trauma (complications, mortality)
• Craniotomy
• Female
• Hematoma, Epidural, Cranial (etiology, mortality, surgery)
• Humans
• Male
• Middle Aged
• Prognosis
• Prospective Studies
• Time Factors
• Treatment Outcome